Healthcare Provider Details

I. General information

NPI: 1932651304
Provider Name (Legal Business Name): TORY EYLAR CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 LACKMAN RD APT 1105
SHAWNEE KS
66217-8312
US

IV. Provider business mailing address

7150 LACKMAN RD APT 1105
SHAWNEE KS
66217-8312
US

V. Phone/Fax

Practice location:
  • Phone: 913-426-3455
  • Fax:
Mailing address:
  • Phone: 913-426-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number166588
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: